Impulse phobia: symptoms, causes, and treatment.

A review of this disorder in which there is a fear of losing control and giving in to impulses.

People maintain a continuous mental activity. We are rational beings who construct our reality through thought, which is why thought never ceases in its effort to give meaning to what surrounds us.

Every human work, without exception, was a thought before it became tangible. Therefore, we must appreciate its importance in the creative process, as well as its intimate relationship with behavior and emotion.

Impulse phobia emphasizes this indivisible link between thinking and acting, but with a pernicious nature.It has a pernicious nature that generates great discomfort in those who experience it.

In this article we will review the concept, as well as its characteristics and its consequences on health and quality of life, along with the therapeutic modalities available today to address it successfully.

Phobias: characteristics and symptoms

The phobias are disorders of anxiety that are characterized by the appearance of a response of disproportionate fear before the presence of stimuli or very concrete situations, which activate the natural mechanisms of alarm in order to respond to what is perceived as a threat.. To understand them we can resort to the metaphor of allergies, which stand as excessive reactions of the immune system to substances or other generally innocuous elements (but which are faced as a dangerous pathogen).

As we will see, impulse phobia has this main characteristic, although it is true that it also shares features of impulse control disorders. also shares features of impulse control disorders and OCD. and OCD.

Returning to phobias in general, it is also important to bear in mind that their onset and maintenance depend on different explanatory mechanisms. They are formed from direct and adverse experience with the object that will later be feared, or by vicarious/social learning (seeing another person being exposed to the stimulus or hearing negative stories about it), but the continuity of the problem is rooted in attempts to avoid or escape from it. The latter motivate a misleading sense of relief, as it ends up extending the problem over time.

In this sense, the affected person articulates cognitive and behavioral strategies aimed at avoiding any coincidence with that which frightens him/her, because when he/she does so, he/she experiences a succession of sensations (autonomic hyperarousal) and cognitions that are difficult to bear. The range of situations or other stimuli that can be associated with this irrational fear is almost infinite, which is why so many new ones are created.The range of situations or other stimuli that can be associated with this irrational fear is almost infinite, which is why so many labels are created to define it.

People suffering from specific phobias rarely go to a psychologist to treat the problem, because if the triggering stimulus is infrequent or can be avoided without major consequences for life, adaptation to the changes it causes is simple and does not affect either autonomy or well-being. On the other hand, when what is feared cannot be avoided, fear becomes an omnipresent and disabling emotion, which generates anxiety-related symptoms: cold sweats, irritability, muscular tension, etc.

The latter makes impulse phobia a really severe problem, since, as we shall see below, it constitutes an intense fear of a stimulus from which escape can be really difficult: intrusive thoughts and their possible behavioral consequences (impulses).

What is impulse phobia?

Impulse phobia is a specific form of fear that is not projected towards an external object, but inward.. Specifically, sufferers have an intense fear of certain types of thoughts, which they find very difficult to share.

These are seemingly innocuous mental contents, but they are understood in terms of threat and burst in unexpectedly. But in the case of impulse phobia, just as important as the way these thoughts make us feel is the way they make us predict the way we will feel and act in the immediate future.

And the fact is that impulse phobia generates a logic of self-fulfilling prophecy (as is often the case with anxiety disorders in general), such that that which is feared or which generates anguish captures our attention in a constant way..

To exemplify the problem, we will divide it into smaller parts and address each of them separately. We will thus distinguish between thought, interpretation and behavior.

1. Thinking

All of us have at one time or another experienced a thought that arose automaticallywithout the mediation of our will. Very often we may be able to observe it and discard it, because we do not recognize in it anything that can be of use to us, or because we understand it as a harmless word or image that will vanish as soon as we decide to focus our attention on other things around us.

In other cases it is possible that an idea arises that generates a severe emotional impact on us, because we interpret it in terms of harm or danger. These may be issues related to acts of violence directed at ourselves or others, sexual behavior that we judge to be deeply abhorrent, or expressions that go against deep values (blasphemies in people who harbor deep religious beliefs, for example).

It is a mental content that appears suddenly and may or may not be associated with a situation we are experiencing. Thus, it would be possible that while walking along a cliff, the idea of jumping into the void would suddenly arise, or that being accompanied by a person (with whom we have a close bond) a bloody scene would emerge in which she would be the protagonist. In other cases, however, it can happen without an obvious environmental trigger.

The very fact of being the receptacle of these ideas can alert the person to the possible underlying motives, since they they are in direct opposition to what he/she would do in his/her daily life (he/she would never (he would never commit suicide or harm a loved one). It is at this precise moment that such mental contents reach the realm of psychopathological risk, since they precipitate a cognitive dissonance between what we believe ourselves to be and what the thoughts seem to suggest we are.

2. The interpretation

The interpretation of intrusive thoughts is an essential factor in precipitating this phobia.. If the person dispossesses them of any sense of transcendence, they are diluted and cease to generate a pernicious effect on his mental life. On the other hand, if a deeper meaning is attributed to them, they take on a new dimension that affects the self-concept and promotes a sense of distrust of oneself and one's own cognitive activity.

One of the characteristic phenomena of this phobia is the connection that is forged between thought and potential behavior. Thus, when accessing consciousness, the person fears losing control of himself and being overwhelmed by the impulse to carry out the acts that relate to him. Following the previous example, she would feel an irresistible fear of falling from a great height or of harming the family member who was accompanying her. Thus, a fusion between thought and action arises.

This connection can lead to doubts as to whether the doubts as to whether the thought is a figment of the imagination or whether it is the memory of an event that really happened at a time in the past. at some point in the past. All this provokes emotions that are very difficult to tolerate and a significant confusion, which also forces doubts about the motive that could be at the basis of thinking as one thinks (to consider oneself a bad person, to be losing one's mind, to suffer from hidden impulses or to be an offense in the eyes of a God in whom one believes).

For this reason, impulse phobia is not only linked to an intense fear of thoughts that might precipitate a loss of control, but it conditions the self-image and severely impairs the way in which the person perceives him/herself.. For this reason, talking about what is happening can be extremely painful, delaying the therapeutic approach to the problem.

3. Behavior

As a result of the fear generated by these thoughts and their possible consequences, the person tries to avoid them by making use of all the means at his disposal.

Most commonly, the person first tries to impose his or her will on the speech of the mind (which seems to flow automatically), seeking a deliberate disappearance of the mental contents that generate the emotion. This fact usually precipitates the opposite effect, through which its presence becomes more frequent and intense. Being a purely subjective phobic object, the person feels the source of his or her fears as omnipresent and erosive, and a sense of loss of control quickly emerges, leading to helplessness.

Other behaviors that may occur are reassurance behaviors. They consist of persistently inquiring as to whether or not the events that have been thought about have occurred, which involves verifications that acquire the severity of a compulsive ritual. In addition, there may also arise the tendency to continually question others about these same facts, pursuing the judgment of others.In addition, there may also arise the tendency to continually question others about these same facts, seeking the judgment of others in order to draw one's own conclusions about them.

Both types of behavior, the avoidance of subjective experience and the reassurance about one's own actions, constitute the basic elements for the aggravation and maintenance of the problem in the long term. They can also be articulated in a progressively more complex way, in such a way that it ends up hindering the normal development of daily life (avoiding situations or people that have been associated with the occurrence of thoughts, for example).

Treatment

Impulse phobia can be successfully treated. For this purpose there are both pharmacological and psychotherapeutic interventions..

In the first case, benzodiazepines are usually used on an ad hoc basis and for a short period of time, while the changes required for an Antidepressant to begin to generate its effect take place (approximately two or three weeks). Selective serotonin reuptake inhibitors are usually used, which help to reduce the presence of negative automatic thoughts.

As for psychological treatments, which are absolutely necessary, specific cognitive and behavioral strategies are usually used, aimed at modifying the way in which the thoughts and associated sensations are perceived (live exposure, cognitive restructuring, etc.). These procedures include controlled exposure and systematic desensitization.In these sessions, the patient is facilitated to face the situations that produce the phobic reaction without losing control, and allowing time to pass until the anxiety levels decrease. In this way, as the patient progresses through a series of situations ranging from the easiest (in the first psychotherapy sessions) to the most difficult (in the last sessions), the impulse phobia loses power and finally ceases to be a problem.

On the other hand, cognitive restructuring is also used to help weaken the dysfunctional beliefs that keep the impulse phobia "alive"; this is something that is achieved mainly through dialogues based on questions that the patient must ask himself, and in which he sees that his habitual way of thinking not only does not fit with reality, but causes him problems.

Acceptance and Commitment Therapy is also useful.It emphasizes the importance of experiential avoidance, a key phenomenon in impulsion phobia. In this type of therapy, the patient is encouraged to adopt a mentality in which there is no obsession to avoid discomfort at all costs.

This type of interventions in patients, in the case of those who have impulsion phobia, helps them to face the symptoms without giving in, getting used to associate the presence of this discomfort, on the one hand, with the non-occurrence of their fears, on the other hand.

Finally, it will be necessary to rule out the presence of other mental disorders that could express themselves in a similar way as this particular type of phobia does, such as Obsessive-Compulsive Disorder, and to rule out mood pathologies in which its occurrence may also concur (especially major depression).

Bibliographical references:

• American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Arlington: American Psychiatric Publishing.
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• Coelho, C. y Purkis, H. (2009). The Origins of Specific Phobias: Influential Theories and Current Perspectives. Review of General Psychology, 13(4): pp. 335 - 348.
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